Neonatal Candida arthritis

Pediatric Fungal Septic Arthritis Following Intra-articular Administration of the Two-Month Vaccination: A Case Report

The majority of pediatric fungal septic arthritis patients are infants. Risk factors include prematurity and neonatal septicemia with prolonged hospitalization. Here, we present a case of a two-month-old male infant, preterm at 28 weeks and NICU graduate. He was transferred to King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia due to left hip septic Candida arthritis that was unresponsive to antifungal treatment in an outside hospital. Initially, he was administered the two-month scheduled vaccines inadvertently in the intra-articular space of the left hip. Three days later, he developed candidemia and symptoms of septic arthritis in the left hip. Joint aspiration grew Candida and he was then commenced on anti-fungal treatment. In our hospital, he was vitally stable and febrile. Examination showed erythema, warmth, and severe tenderness, with pain and reduced range of motion of the left hip. Inflammatory markers were increased. X-ray of the left hip was unremarkable. MRI with contrast showed mild left hip effusion associated with synovial enhancement and soft tissue edema and enhancement. Incision and drainage was done after which he received vancomycin and meropenem for four weeks along with fluconazole for eight weeks. A back slab was applied for four weeks. The patient achieved successful recovery upon completion of the treatment and incision and drainage. To our knowledge, this is the first reported case of fungal septic arthritis as a consequence of intra-articular vaccination administration. This case highlights the importance of considering fungi as an etiology of pediatric septic arthritis, particularly in patients with the aforementioned risk factors.

Neonatal Osteomyelitis

Osteomyelitis is a serious and potentially life-threatening condition affecting the skeletal system of newborns. The condition is relatively rare in neonates but occurs at higher rates in high-risk pregnancies, in preterm infants, and with the use of invasive devices. As a result of the anatomy and immature immune system of newborns, neonates differ in presentation, diagnosis, and management of osteomyelitis compared to patients of other age groups. An understanding of these differences will assist clinicians in the prompt diagnosis and management of this neonatal infection and lead to improved long-term outcomes.

Osteoarticular Mycoses

Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.